Electroconvulsive Therapy

electroconvulsive therapy

What Is Electroconvulsive Therapy?

Electroconvulsive therapy (ECT) is a treatment for certain mental illnesses. During this therapy a precise, timed electrical current is passed through a patient’s brain in order to induce a seizure. The procedure is most often used to treat patients who do not respond to medication or talk therapy.

ECT has also been called electroshock therapy.

What Is ECT Used to Treat?

ECT is most often used as a “treatment of last resort” for the following disorders:

  • bipolar disorder: This mood disorder is characterized by periods of intense energy and elation (mania) followed by severe depression.
  • major depressive disorder: This is a common mental disorder. Patients experience frequent low moods and a lack of self-esteem. They may also experience an inability to enjoy once-pleasurable activities.
  • schizophrenia: This psychiatric disease typically causes paranoia, hallucinations, and delusions.

How Effective Is ECT?

According to an article published in the Journal of the Royal Society of Medicine, 83 percent of depressed patients who did not respond to other treatments did improve after ECT. (Hughes et al ) In addition, patients who are treated with ECT have a 49 percent remission rate. This compares to a 21 to 30 percent rate for those taking medications.

The reason ECT is so effective remains unclear. Some researchers believe it helps to correct an imbalance in the brain’s chemical messenger system. Another theory is that the seizure somehow “resets” the brain.

Today, both the American Medical Association (AMA) and the National Institutes of Mental Health (NIMH) support the use of ECT. However, ECT has a checkered past. Because of this, it is considered one of the most controversial treatments in modern psychiatry.

History of ECT

When ECT was first introduced in the 1930s, it was known as “electroshock therapy.” It didn’t take long for the procedure to earn a bad reputation. In its early use, patients regularly suffered broken bones and related injuries during therapy. Muscle relaxants weren’t available to control the violent convulsions caused by ECT.

In modern ECT, electrical currents are administered more carefully. The patient is also sedated to reduce the risk of injury. ECT is “far and away the most effective treatment that currently exists for depression,” affirms Irving M. Reti, Assistant Professor of Psychiatry at Johns Hopkins University School of Medicine. It helps 85 percent of severely depressed patients for whom medications don’t work (Reti).

Types of ECT

There are two major types of ECT—unilateral and bilateral.

In bilateral ECT. electrodes are

placed on either side of the head. The treatment affects the entire brain.

In unilateral ECT. one electrode is placed on the top of the head. The other is placed on the right temple. This treatment affects only the right side of the brain.

Some hospitals employ “ultra-brief” pulses during ECT. These last less than half a millisecond, compared to the standard one millisecond pulse. The shorter pulses are believed to help prevent memory loss.

What to Expect

To prepare for ECT, you will need to stop eating and drinking for a specified period of time. You may also need to change your medication. Your doctor will let you know how to plan.

On the day of the procedure, you will be given general anesthesia and muscle relaxants through an IV (directly into a vein). These prevent convulsions. You will fall asleep before the procedure and not remember it afterwards.

A doctor will place two electrodes on your scalp. A controlled electrical current will be passed between the electrodes. This current causes a brain seizure (a temporary change in the brain’s electrical activity). It will last between 30 and 60 seconds.

During the procedure, your heart rhythm and blood pressure will be monitored. In outpatient procedures, you’ll typically go home the same day.

Most people receive benefits from ECT in as few as eight to 12 sessions over three to six weeks. Some patients require a once-a-month maintenance treatment.

Benefits of ECT vs. Other Therapies

ECT works for many people when drugs or psychotherapy are ineffective. There are typically fewer side effects than with medications.

ECT works quickly to relieve psychiatric symptoms. Depression or mania may resolve after only one or two treatments. In contrast, many medications require weeks to take effect. Therefore, ECT can be especially beneficial for those who are suicidal, psychotic, or catatonic.

ECT may be safely used on both pregnant women and those with heart conditions.

Side Effects of ECT

Side effects associated with ECT are rare and generally mild. They can include

  • headache or muscle ache in the hours following treatment
  • confusion, shortly after treatment
  • short-term memory loss, which may last for weeks
  • irregular heart rate (rare)

ECT can be fatal, but deaths are extremely rare. According to Johns Hopkins Medicine, only an estimated one in 10,000 people die from ECT. This is much lower than the 15 percent suicide rate in people with severe depression. (All About Depression.com )

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